Individual
AMANDA M CONVERSE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
525 ELLIOTT AVE, GRAND HAVEN, MI 49417-1038
(616) 566-1603
Mailing address
525 ELLIOTT AVE, GRAND HAVEN, MI 49417-1038
(616) 566-1603
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
7501002519
—
225700000X
Massage Therapist
Primary
7501002519
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7501002519
LICENSE NUMBER
MI
Enumeration date
10/21/2020
Last updated
11/05/2020
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